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In Reply:

I thank Dr. Verma and Dr. Bohnen for their comments. They are clearly onto something. We would not expect medical students and residents who had not been educated in a basic science such as physiology or a clinical discipline such as pediatrics to develop interest and expertise in such areas. Hence we should not expect learners who receive little education or encouragement in the area of leadership to develop into committed, effective leaders. We cannot build great medical care on a foundation that includes only the biology of molecules, cells, and organs. No less important is attention to the organizational dimension of health care, where many facets of the patient-physician relationship are shaped. For this reason, every medical student and resident should be exposed to basic principles of the organizational domain of health care, and students who show special interest or aptitude should enjoy opportunities to explore such principles further. These opportunities should include not only formal coursework but also hands-on projects that offer practical and short-term benefits to the profession of medicine, health care organizations, and patients. We cannot achieve first-class medicine without first-class medical leadership.